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Fraud Case Rocks Anesthesiology Community


THE INDEPENDENT MONTHLY NEWSPAPER FOR ANESTHESIOLOGISTS
Last Update: February 18, 2011
Policy & Management

ISSUE: MARCH 2009 | VOLUME: 35:3

Fraud Case Rocks Anesthesiology Community
Mass. Researcher Implicated in Falsification of Data, Other Misdeeds
by Adam Marcus
In what experts are calling one of the largest known cases of academic misconduct, a leading anesthesiology researcher has been accused of falsifying data and other fraud in potentially dozens of published studies.

Scott S. Reuben, MD, of Baystate Medical Center in Springfield, Mass., a pioneer in the area of multimodal analgesia, is said to have fabricated his results in at least 21, and perhaps many more, articles dating back to 1996. The confirmed articles were published in Anesthesiology,Anesthesia and Analgesia, the Journal of Clinical Anesthesia and other titles, which have retracted the papers or will soon do so, according to people familiar with the scandal (see list). The journals stressed that Dr. Reuben’s co-authors on those papers have not been accused of wrongdoing.

In addition to allegedly falsifying data, Dr. Reuben seems to have committed publishing forgery. Evan Ekman, MD, an orthopedic surgeon in Columbia, S.C., said his name appeared as a co-author on at least two of the retracted papers, despite his having had no hand in the manuscripts. “My names were forgeries on the documents,” Dr. Ekman told Anesthesiology News.

Dr. Reuben has been an extremely active and visible figure in multimodal analgesia, particularly as an advocate for its use in minimally invasive orthopedic and spine procedures. His research has provided support for several mainstays of current anesthetic practice, such as the use of nonsteroidal anti-inflammatory drugs and neuropathic agents instead of opioids and preemptive analgesia. Dr. Reuben has also published and presented data suggesting that multimodal analgesia can significantly improve long-term outcomes for patients.

Incomprehensible Course

All of that is now in question, said Steven L. Shafer, MD, editor-in-chief of Anesthesia and Analgesia, which retracted 10 of Dr. Reuben’s articles. “We are left with a large hole in our understanding of this field. There are substantial tendrils from this body of work that reach throughout the discipline of postoperative pain management,” Dr. Shafer said. “Those tendrils mean that almost every aspect will need to be carefully thought through. What do we still believe to be true? Do the conclusions hold up to scrutiny?”

Dr. Shafer said that although he still believes “philosophically” in multimodal analgesia, he can no longer be absolutely certain of its benefits without confirmation from future studies.

Dr. Shafer called the scandal “a tragedy” for the profession, for patients and for Dr. Reuben personally. “I cannot begin to comprehend why a person would take this course,” he said of the research fraud.

Efforts to reach Dr. Reuben were unsuccessful.

Internal Inquiry Revealed Sweeping Misconduct

The retractions came after an internal investigation by Baystate turned up evidence of widespread fraud in Dr. Reuben’s research. Jane Albert, a spokeswoman for Baystate, said the inquiry was undertaken after an internal reviewer at the medical center had raised questions last year. Ms. Albert said the hospital’s investigation raised “no allegations concerning any patient care. This was focused on academic integrity.”

Dr. Reuben is on medical leave from his position as chief of the acute pain service at Baystate, Ms. Albert said.

Dr. Reuben, who was educated at Columbia University and received his medical degree from SUNY at Buffalo School of Medicine, is well-known among anesthesiology researchers for his studies of multimodal analgesia, the practice of combining several forms of pain relief to better control postoperative discomfort and promote faster recovery from surgery.

Rumors of a problem with Dr. Reuben’s research have been circulating among academic anesthesiologists for a year, according to people familiar with the matter.

“Interestingly, when you look at Scott’s output over the last 15 years, he never had a negative study,” said one colleague, who spoke on the condition of anonymity. “In fact, they were all very robust results—where others had failed to show much difference. I just don’t understand why anyone would do this or how anyone could pull this off for so long.”

A recent PubMed search for Dr. Reuben’s name turned up 72 citations, the most recent an article in the December issue of the Journal of Cardiothoracic and Vascular Anesthesia on preventing the development of chronic pain after thoracic surgery.

“Massive” Breach of Trust

Josephine Johnston, an attorney specializing in research integrity at the Hastings Center, in Garrison, N.Y., called the scope of the Reuben fraud “massive.”

“It’s usually just one article, not a body of work,” Ms. Johnston said.

What’s particularly surprising given the dimensions of the case, Ms. Johnston said, is that Dr. Reuben’s research managed to raise no alarms among peer reviewers. However, she added, “the peer review system can only do so much. Trust is a major component of the academic world. It’s backed up by the implication that your reputation will be destroyed if you violate that trust.”

Click here for the original article online.
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N.J. tax to help low-income people pay cable TV bills was instead used to plug budget hole

N.J. tax to help low-income people pay cable TV bills was instead used to plug budget hole

Published: Sunday, February 06, 2011, 6:00 AM     Updated: Sunday, February 06, 2011, 7:43 AM
cable.JPG
Noah Addis/For The Star-LedgerRichard Hersh poses for a portrait in his apartment in Collingswood on Saturday. Cable television companies have been paying a tax that was supposed to go into a fund to help lower cable bills for low-income elderly and disabled people. The fund was never created and the money was used to help close the budget gap this year. Hersh, who pays $122 a month for cable and internet, wishes the fund was available.

TRENTON Five years ago, the state promised poor senior citizens and disabled people they could expect help paying their cable television bills under a tax imposed on the cable industry.

Since then, the state has collected a total of $9.2 million from the tax — but not a dime has gone to help low-income cable subscribers.

After Gov. Jon Corzine signed the law creating the fund in 2006, no one ever developed a plan to disburse the money. It sat untouched and accumulating until Gov. Chris Christie drained the fund to help plug a big state budget hole last year, state Treasury Department spokesman Andy Pratt confirmed.

Although the tax money was earmarked for the Cable Television Universal Access Fund, “the money is all gone now,” Pratt said. “The money was never used for the intended purpose.”

Lawmakers who sponsored the bill said they didn’t know the money never went to needy residents, saying for some, cable TV provides a lifeline to the world. Christie’s critics said it shows a disregard for the needs of New Jersey’s most vulnerable citizens.

“This points up the disastrous effect of foot-dragging on regulation writing,” said Sen. Loretta Weinberg (D-Bergen), chairwoman of the Senate Health, Human Services and Senior Citizens Committee who criticized the “bureaucrats that dragged their feet” during Corzine’s term.

“It also points up that Christie has taken more money away from poor people in this budget — a tax earmarked for a special program and he put it into a general fund,” Weinberg said.

Collingswood resident Richard Hersh, 67, disabled since a serious car accident in 1994 left him with chronic nerve condition, said he could use a break on his $122-a-month cable bill. He’s considering dropping the TV service and just keeping the internet to save about $40 because he barely meets expenses on his Social Security check. But he would miss it.

“I don’t have much else I can do. I can’t work. I am sort of relegated to staying in my apartment,” said Hersh, who was a marketing consultant until the throbbing pain from his condition, reflex sympathetic dystrophy, ended his career.

“That program would have been great,” he said.

Laws that earmark money for a specific purpose do not require governors to spend it. For years, governors have tapped a wide range of revenue sources to balance the budget.

“The budget bill supercedes all other bills,” Pratt said. “All state revenue goes into the general fund unless voters have passed a referendum and dedicated it” for a specific purpose.

Spending the money was justified by the “unprecedented budget crisis that was faced by this administration that involved cuts in nearly every single program,” Pratt said.

Michael Drewniak, a spokesman for the governor, declined comment.

The fund was created under a broader law that imposed regulations when telephone service provider Verizon wanted to break into the cable business. The law requires Verizon and cable companies Cablevision, Comcast and Time Warner to pay a 4 percent tax on revenue, with one-half of 1 percent earmarked for people enrolled in Pharmaceutical Assistance to the Aged and Disabled, a state program providing low-cost prescription drugs.

About 174,000 people belong to PAAD, as it’s commonly known. They qualify if they are single and earn less than $24,432 a year, or married and make less than $29,956.

Stefanie Brand, director of the Division of Rate Counsel, the state’s consumer advocacy agency, said she recalled some agencies were working on rules for the program about 18 months ago, before Corzine left office. Brand said the fund would have filled a void because there are no subsidy programs for cable TV.

“Unlike electric and gas, water and telephone, cable is not viewed so much as an essential service,” Brand said.

The average monthly cost for expanded basic service is $61.19, according to the state Board of Public Utilities.

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Noah Addis/For The Star-LedgerRichard Hersh poses for a portrait with Charlie, his 11-year-old toy Yorkshire Terrier, in his apartment in Collingswood on Saturday. Cable television companies have been paying a tax that was supposed to go into a fund to help lower cable bills for low-income elderly and disabled people. The fund was never created and the money was used to help close the budget gap this year. Hersh, who pays $122 a month for cable and internet, wishes the fund was available.

“I wouldn’t give up on this program,” Brand said. “We may start to see money flow out in the coming months or years.”

Assemblyman Upendra Chivukula (D-Somerset) one of the law’s prime sponsors, called the long-ignored fund “a sad state of affairs.” He said he would ask the BPU if it had dropped the ball. “In these economic times, people are struggling, and cable TV is a window to the world.”

When asked why the money never got to PAAD recipients, board spokesman Doyal H. Siddell said, “We can’t comment on the actions of the prior administration.”

A spokesman for the New Jersey Cable Telecommunications Association declined to comment.

Assemblyman Joseph Malone (R-Burlington) another sponsor, also said he would investigate.

“Having cable TV is like having a lifeline for many people,” he added.

The tax currently generates about $3.5 million a year, and it continues to be collected, Pratt said. No decision has been made on whether the Christie administration will dip into the fund again as officials prepare the coming year’s budget. “What they will do will be part of the budget talks,” Pratt said.

Sen. Joseph Vitale (D-Middlesex) said the governor should find a way to dole out this money.

“The administration can find money for projects they like, like vouchers and charter schools. Why not for seniors or disabled people to minimize the cost of watching TV?” he said.

Hersh agrees, recalling he once called his cable provider, Comcast, to see if there were any discounts for people with disabilities. “The woman told me you could always discontinue it,” Hersh said. “I thought that was a nice, snippy answer to what I thought was a serious question.”

“Thought has to be given to who it hurts or benefits by eliminating this program,” he added. “If I could bring down my cable bill $30 or $40 a month, it would mean a lot to me.”

Click here for the original article online.

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How to treat an intense pain condition? This Web chat Wednesday can offer some help


How to treat an intense pain condition? This Web chat Wednesday can offer some help

By Mary Forgione, Tribune HealthFebruary 8, 2011, 4:10 p.m 

Complex regional pain syndrome doesn’t turn up on most people’s radar unless they or someone they know has the condition. Even so, CRPS, as its called, can lead to continuous, intense pain with no specific cause. A pain expert can explain further and offer some advice on treatment. 

Dr. Paul Christo, a pain medication specialist at Johns Hopkins Hospital, will be the guest on alive Web chat Wednesday (noon EST, 11 a.m. CST, 9 a.m. PST) to discuss the condition often characterized by intense or burning pain, usually in the arms, hands, legs or feet. Christo will discuss the nature of the condition and the latest thoughts on treatment.

The National Institutes of Health describes thesymptoms of CRPS this way:

“The key symptom of CRPS is continuous, intense pain out of proportion to the severity of the injury (if an injury has occurred), which gets worse rather than better over time. CRPS most often affects one of the extremities (arms, legs, hands, or feet) and is also often accompanied by:

-“burning” pain;
-increased skin sensitivity;
-changes in skin temperature: warmer or cooler compared with the opposite extremity;
-changes in skin color: often blotchy, purple, pale, or red;
-changes in skin texture: shiny and thin, and sometimes excessively sweaty;
-changes in nail and hair growth patterns;
-swelling and stiffness in affected joints; and -motor disability, with decreased ability to move the affected body part.”

The condition clearly can be debilitating. Join the online discussion to better understand CRPS and ask a question or two.

Click here for the original article online.

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UPDATE:

Click HERE to read the transcript of the Feb 9th discussion with Dr. Paul Christo of Johns Hopkins re: Complex Regional Pain Syndrome (Reflex Sympathetic Dystrophy Syndrome)

Veteran struggles with constant pain

Veteran struggles with constant pain

Some push to have little-known debilitating syndrome given VA rating system code

Former Marine Kevin Shear, writhes in pain on Dec. 7 before he is taken to the hospital for intravenous medication. Shear, of Crystal Lake, suffers from complex regional pain syndrome. (Stacey Wescott, Chicago Tribune / December 7, 2010)

When Kevin Shear falls asleep, the pain barrels into his dreams, sometimes as an animal ravaging his right leg or shattered glass tearing at the limb.

The former Marine from Crystal Lake suffers from an unusual condition that attacks the central nervous system and leaves him in constant anguish, much like amputees who feel pain in their “phantom limb.”

The illness, complex regional pain syndrome, can cause lifelong medical nightmares for some adults and even children, usually after a mild trauma inflames the nerves, causing pain that never shuts off — even after the original injury heals.

Today, more veterans are complaining about the condition, which they believe derived from injuries suffered in the service — in Shear’s case, an ankle sprain during a training exercise. Because the malady isn’t formally recognized by the U.S. Department of Veterans Affairs, Shear and others say they find it difficult to get benefits from the government.

The veterans say they have lived in silence for too long and believe the military will see more of these cases as injured soldiers seek medical care. Although there is no way to know how many vets suffer from the pain syndrome, the number of appeals for disability compensation that cite the illness rose to nearly 600 in 2009, up from 330 in 2005, according to the Board of Veterans’ Appeals. The board lists about 500 cases related to the syndrome for 2010.

“It’s hard for people like us to mobilize,” said Shear, 34, who added that he has passed out from the burning pain and can no longer work or care for his 2-year-old son. “It’s hard to do anything. That’s why they call it the silent suffering.”

Shear has joined a campaign to raise public awareness and push for the VA to update its coded list of disabilities. An Air Force Reserve colonel suffering from the syndrome has led the charge in seeking compensation for hundreds of other military personnel returning from service. Many complain they have found little support from a federal agency already besieged with head injuries and post traumatic stresssyndrome.

The VA compensates veterans for injuries related to complex regional pain syndrome, said Thomas Pamperin, the agency’s deputy undersecretary for disability assistance, based in Washington.

But he doesn’t believe it is necessary to assign a code to every disability, saying “our ratings schedule is flexible enough to evaluate any recognized condition.”

Most patients refer to the condition by its former name — reflex sympathetic dystrophy. It usually begins with a searing or stabbing pain that is disproportionate to the original injury and persists longer than the expected healing time. The first signs may include a hypersensitivity to touch, swelling and skin discoloration, altered temperature and abnormal sweating.

The pain ebbs and flows daily, causing anxiety when patients believe they have improved only to have it return, sometimes much later, said Dr. Timothy Lubenow, professor of anesthesiology at Rush University Medical Center.

No one is sure how many people suffer from the illness, which can be cured if caught early, Lubenow said. The Reflex Sympathetic Dystrophy Syndrome Association based in Milford, Conn., estimates there are 50,000 new American patients annually, based on Norwegian studies.

Few doctors understand it, and many don’t know how to best treat it, Lubenow said.

“It was initially ascribed to people in the Civil War who had gunshot injuries,” Lubenow said. “It is not as infrequent as one would think. … It isn’t always as readily recognized as it should be because early on it may present with relatively mild symptoms.”

Shear’s first sign of trouble began one year after he joined the Marines, when he sprained his right ankle in 1998.

His leg swelled for three months, and the pain remained long after the sprain healed, he said.

In 2001, he was diagnosed with the syndrome and got a series of injections to block the sympathetic nerves, which run along the spinal column and provide sensation to the legs. He immediately felt better. A neurologist at the Naval Medical Center in San Diego told him he was cured, he said.

His wife, Amy, said Kevin was fit and healthy when she met him in 2005 and they married a year later. The two joined a gym, took up ballroom dancing and had a son, Lincoln. Kevin Shear started a business, teaching guitar to more than 20 students.

Then one day in September 2009, the pain returned with a vengeance.

Shear sought help at the North Chicago VA Medical Center but said he was treated so badly there that he contacted Rep. Don Manzullo, R-Ill., to complain.

North Chicago VA’s spokesman declined to comment on Shear’s case because of privacy concerns but stated: “Any eligible patient who comes to us with pain will receive medical care and will be treated regardless of the medical condition.”

Shear now travels for treatment to the Milwaukee VA hospital, where a spinal cord stimulator was implanted in his back.

His condition has improved, he said, but he cannot walk for more than 10 minutes or sit for longer than 45 minutes without severe pain. He takes a slew of medications, including painkillers and muscle relaxants, and grimaces at the touch of a blanket or brush of a hand.

His mother recently drove him to a hospital’s emergency room in Woodstock when pain overwhelmed him — a trip he has made a half-dozen times over the past year. There, doctors could do little but administer pain medication intravenously.

“It’s horrible to watch your son go downhill like this,” said his mother, Wendy Shear, who baby-sits the couple’s son at her home. “People don’t believe me. Friends don’t believe me. They say it will get better. It’s hard, especially for him. He’s very much alone.”

Shear can no longer embrace his wife, pick up his son or play his guitar. He finds solace in art, music and writing poetry.

Some people with the syndrome suffer from much less pain and can hold jobs.

But if left untreated for too long, the nerve damage can spread to other parts of the body, said Air Force reservist Col. Doug Strand, 51, of Hampton, Va. He said he developed the syndrome after injuring his left leg in 2008, and now copes with problems affecting his lungs.

In October, Strand testified in Washington before a committee that is revamping the veterans disability-rating system. If the pain syndrome were assigned its own code, some veterans could see their monthly disability pay increase by hundreds of dollars, he said.

“You cannot survive on $300 per month,” Strand said. “That is what happens with so many veterans. They say what do I do now? I can’t stand, I can’t walk. I can’t work. …”

After living daily with pain, many patients experience depression and undergo personality changes, experts said. What exacerbates the problem is that people who aren’t familiar with the syndrome don’t understand its debilitating effects.

Jim Broatch, executive director of the Reflex Sympathetic Dystrophy Syndrome Association, started a Web page devoted specifically to veterans after hearing complaints from returning soldiers.

“I always laugh when they say, ‘It’s in your head,'” Broatch said. “I say, ‘Damn right.'”

 

 

Click here for the original article online.

 

 

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Digital Tylenol: Microchip Embedded Into Spine Stops Chronic Pain

Digital Tylenol: Microchip Embedded Into Spine Stops Chronic Pain

Researchers and designers at the National ICT Australia in Sydney have constructed a smart chip that,when embedded in the spine, intercepts and blocks pain messages to the brain.

The chip is housed in a biocompatible casing that is smaller than the head of a match. In turn, the chip is wired to a larger implanted device containing a battery, which charges wirelessly from an outside source, and a computer processor.

The chip is embedded to the spine, or another area between the brain and source of pain. The chip can measure the properties of signals and pick out the ones that are carrying pain to the nerve center. When the chip detects a pain signal headed towards the brain, it shoots out a 10-volt electric pulse that blocks the pain signal.

The device is designed for those with serious or chronic back or leg pain, however, it technically can be used for all kinds of pains throughout the body.

National ICT Australia

[via Popular Science]

 

 

Click here for the original article online.

 

 

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Scans prove that acupuncture induces clear metabolic brain changes that eliminate pain

Scans prove that acupuncture induces clear metabolic brain changes that eliminate pain
(NaturalNews) New research adds more evidence proving that acupuncture is effective at reducing and eliminating pain. Presented at the annual meeting of the Radiological Society of North America (RSNA), the new findings include functional magnetic resonance imaging (fMRI) scans that clearly show a positive change in the metabolic activity of patients’ brains receiving acupuncture treatment.

“Functional MRI gives us the opportunity to directly observe areas of the brain that are activated during pain perception and see the variances that occur with acupuncture,” explained lead researcher Nina Theysohn, MD, from the Department of Diagnostic and Interventional Radiology and Neuroradiology at University Hospital in Essen, Germany. “Activation of brain areas involved in pain perception was significantly reduced or modulated under acupuncture.”

Eighteen volunteers agreed to participate in the study, and all were observed using fMRI technology. Researchers applied electrical pain stimuli to the participants’ left ankles and observed their brain activity both with and without acupuncture treatment. The team found that the pain activation centers in the participants’ brains became less active and even deactivated in the presence of acupuncture treatment.

The findings also challenge some notions that acupuncture works primarily as a placebo. While certain brain responses to acupuncture indicate facets of a placebo response, others clearly highlight specific mechanical activities in the brain that demonstrably reduce pain symptoms.

“Acupuncture is supposed to act through at least two mechanisms — nonspecific expectancy-based effects and specific modulation of the incoming pain signal,” said Theysohn. “Our findings support that both these nonspecific and specific mechanisms exist, suggesting that acupuncture can help relieve pain.”

Acupuncture has also been found to help improve fertility, increase heart function, and assist in helping people sleep.

Click here for the original article online.
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Experts find brain enzyme that makes pain last

Experts find brain enzyme that makes pain last

Thu Dec 2, 2:25 pm ET

SINGAPORE (Reuters) – Researchers working on mice have found an enzyme in the brain that appears to make pain last after nerve injury and they hope to use it as a new target to treat chronic pain in people.

In a paper published in Science magazine Friday, the scientists in Canada and South Korea said they managed to alleviate pain after blocking the enzyme.

“It provides us with basic understanding of the brain mechanism for chronic pain,” lead author Min Zhuo, a physiology professor at the University of Toronto, wrote in an email.

“It not only provides a new possibility to design new pain medicine, but it also helps us to understand why many drugs fail to control chronic pain.”

Although painkillers have existed for long periods of time,

management of chronic pain in hospitals, and for conditions like cancer and end-of-life palliative care, is far from adequate in many places.

Zhuo and colleagues found raised levels of the enzyme “protein kinase M zeta” in a region of the brain called the anterior cingulate cortex of the injured mice.

To confirm the enzyme’s function, they knocked out a gene in another group of mice which they believed was responsible for triggering the production of the enzyme.

They subsequently found that those mice experienced less or no chronic pain at all after nerve injury.

“The knockout mice without this enzyme may experience less or no chronic pain,” Zhuo wrote.

Zhuo and his team hope their work will help in the design of a new class of drugs that blocks this enzyme.

“Many painkillers do not work for chronic pain, especially neuropathic pain. There is great need for new drugs that can effectively control chronic pain,” Zhuo wrote.

(Reporting by Tan Ee Lyn: Editing by Ron Popeski)

 

 

Click here for the original article online.

 

 

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